总论
好痘如塔，层层垒札；低痘如塌，空空蹉压；好痘光艳，珠头桃面；险痘坑陷，溃囊深烂。（华峰道人）
凡气虚之痘初发，身热悠悠，手足厥冷，乍凉乍热，精神倦怠，肌肉晃白，饮食减少，睡卧安静，便清
自调，虚证无疑。未见点前，用参 饮加紫苏、白芷、防风；见点之后，用参 饮加川芎、桔梗。四日之后，
重用参 饮，随证加减。七、八日浆足之后，保婴百补汤，调养气血。○凡血热之痘初发，身热壮盛，腮红脸赤，
毛焦色枯，烦渴饮水，日夜啼哭，睡卧不安，小便赤涩，热证无疑。未出之前，升麻葛根汤，或升麻流气饮；
见点之后，十神解毒汤为稳；至三、四日，热证悉平，势将行浆，从太乙保和汤加减；八、九日浆足之后，则
有保婴百补汤调养之。○表热盛则干枯，表太凉则冰伏。内热盛则秘结，内太凉则泄泻。气壅盛则腹胀喘满。
热毒为所抑而不得伸越，则腹胀狂乱。毒瓦斯弥盛，则表里受重，而婴童难任。是故治痘之法，在安表、和中、
匀气、透肌、解表五者而已。安其表，使无干枯冰伏之患；和其中，使无便结泄泻之变；匀其气，使无壅盛喘
满之过；透其肌，使热毒得以伸越而达表；解其毒，使内外有所分消。五者不失，
则血热壅遏之证，痘虽稠密，亦不足忧。（翁仲仁）
一发便密，情势重者合轻其表而凉其内。若已发，密重微喘，饮水有热者，则祛风药中微利之。若出不快，
便清自调者，知其在表不在里也，当微发散。若青干黑陷，身不大热，二便秘涩者，热在内也，当下之。若身
大热，表证未罢者，则不可下。若痘已出，见小热，小便不利者，当利之。痘后余毒未散，复有身热疮肿者，
宜解毒。已出未出，声不出者，当清肺。（张洁古）
痘有别物乎？气血中淫邪之毒也。治痘有别法乎？消化淫邪之毒，卫全其气血也。故未出则分之，既出则
拒之，既拒则化之。三者得之，而天全矣。（《黄帝逸典》）
桂岩先生云∶痘者，象其形而名之也。愚谓不独象形而名，即治痘之法，亦犹农家之种豆也。豆之为物，
土实则难出，土瘠则难长。故实者锄 之，瘠者灌沃之，不实不瘠，惟顺其性，不使物害之而已。知此则可以
语医矣。今人于痘初起，不察虚实寒热，或过用木香散、异功散之类，则以火济火，致变紫黑、倒陷、痈毒、
吐衄者有之；或妄用芩、连、栀、柏寒凉之药，则大伤脾胃，为吐、为泻、为寒战内陷者有之。故凡治痘之法，
六日之前不宜温补，亦不宜妄用寒凉。师云∶凡解毒之内，略加温补；温补之中，略加解毒。此不传之秘诀也。
（程晨峰）
足热、腮红、大便闭、小便赤、渴不止、上气、脉洪数，七者不得服热药，足冷、腹虚胀、面晃白、便清、
吐乳、目青、脉沉细，七者不得服寒药。（吕沧洲）
痘证有二∶一曰血热毒盛；一曰气虚毒盛。气虚而毒不盛者，可以徐补。血热而毒盛者，其势必急。一发
热便口渴、面赤、气喘、狂躁、谵语；一见点，即宜凉血解毒，磨犀角汁多饮之，十疗四、五，迟难救矣。又
有血热兼气虚者，初发先凉血解毒，五、六朝后，可以并力补气助浆。初时不早凉血，则毒不解，延至六、七
朝，势必以参、 助浆，浆必不来，反滋毒火。又有血
热毒盛，似气虚者，初热放点，神思昏乱，足冷，痘色白，如水窠，惟有唇肿口渴辨其火证。医者不察，反以
气虚治之，十无一生。（缪仲淳）
痘疮气匀即出快。故疮出之时，常宜和暖，如春三月发生之气，则气血和畅，自然出快，其发透，其
齐。若偏于热，则壮火食气，其气反虚而不能行；偏于寒，则气凝涩而不得行。（张从正）
解其火毒，恐郁遏而干枯；养其血气，欲流行而舒畅。（万密斋）
治痘宜解毒、和中、安表。虚者益之，实者损之，冷者温之，热者平之，是为权度。亦如庖人笼蒸之法，
但欲其松耳。○大概灰白色者、静者，作寒看；齐涌者、躁者，作热看。（朱丹溪）
五要∶一、出欲尽；二、起发透；三、脓稠满；四、收 齐；五、结痂浓。○五善∶一、饮食如常；二、
大小便调；三、疮红活坚实；四、脉静身凉，手足温暖；五、声音清亮，动止安和。五者不能全得，得一、二
亦吉。○七恶∶一、烦躁闷乱，谵妄恍惚；二、呕吐泄利，饮食不进；三、黑陷焦枯，痒塌破烂；四、头面预肿，
鼻扇肩抬，目张唇裂；五、喉舌溃烂，食入即呕，水入即呛；六、寒战切牙，声哑色黯；七、腹胀喘促，四肢
逆冷。七者不必皆有，有一、二亦自难为。○痘之形证有四∶曰毒壅，曰血热，曰气虚，曰血虚。又虚实有四∶
表里虚实是也。见点稠密，形不尖松，色多惨黯，欲出不出者，此毒壅也；见点深红，渐变紫黑，夹疔夹斑者，
此血热也；顶陷皮薄，平塌不振者，此气虚也；色淡根散，或痘色与肉色无异者，此血虚也。身微热而有汗，
曰表虚；壮热无汗，喘促皮焦，肌肉痛者，表实也。精神疲倦，唇舌淡白，曰里虚；狂乱气盛，渴饮善食，唇
燥舌黄者，里实也。毒壅血热，同表里之实；气虚血虚，同表里之虚。壅者疏之，热者凉之，虚者补之，实者
泻之，不虚不实，平剂调之。虽然，辨寒、热、虚、实，尤须以舌作纲维。○治痘有四，节次
勿紊，紊则气血颠倒，火毒肆虐，而诸证蜂作矣。故惊者、狂者、吐者、泻者、斑者、疹者、腰腹痛者、肉肿
痘不肿者、呛水挫喉者，皆当发不发，毒壅三焦所致也；焦紫者、枯黑者、渴者、躁者、发疔毒者、胃烂口臭
者，皆当清不清，阳明内热所致也。当补不补，则为白陷、为泄泻、为痒塌、为倒 ，外剥内攻，中气虚也；
当渗泄不渗泄，则身反壮热，或少食吐泻，或肌肉疤烂，何者？脾湿内淫也。标离而异，本合而同，药当其节，
变证息矣。○痘有当汗者，汗之；当汗不汗，后必变证。壮热皮燥，喘促面浮，可汗也。痘隐隐不出，肉肿疮
不肿，毒停不成浆，或因寒倒 ，皆可汗也。但兼解、兼补有殊耳。可清也，可下也，舌之黄燥可验矣；可温
也，可补也，舌之淡润可验矣。○治痘之药不可过。过热则涸，过寒则凝，过燥则耗血，过润则滑肠，过攻则损
真，过补则助邪。○治痘证不治杂证，千古秘论也。杂证有日，痘证只两七日之期，且痘中之杂证，缘失治而作，
今犹治杂证而不治痘，将杂证愈甚而痘愈惫矣。（《慈幼筏》）
杂证缘痘证而生出者，治痘证为当；痘证因杂证而羁绊者，理杂证为良。（徐仲光）
痘如奕棋，变化最多，自古至今无同局。治痘之方亦当随机应变，印板方子使不得。○痘之全体，无非气、
血、毒三字，即从三字推求。然三字要分得开，合得拢，分得开是看法，合得拢是治法。○痘有三关，打得过
方算成功。三关者，出得出、灌得起、收得回是也。○灌之机在出， 之基在灌。未有点不离肉而能灌者，未
有浆色清淡而能 者。○出不出，由乎天；灌不起，由乎体；收不回者，医之罪也。○一见发热，便防其闭，莫
待烦闷斑见，而始觉其闭；一见出齐，便思其灌，莫待灰白紫黑，而始愁其不灌；一见其灌，便思其收，莫待
塌陷倒 ，而始觉其难收。譬之博奕，着着求先，则尽善矣。○痒塌是内攻事；臭烂是外出事；痈肿螺疔，是欲
攻不得攻，欲出不得出事。○痒塌是毒
未化事；鬼肿是毒化一半事；臭烂是毒化已后事；痈肿螺疔，是毒化未尽事。会得此等境界，便识得用药。盖
气血交则毒化。痒塌是气血不曾交会，故不救，鬼肿螺疔，是既交会而中阻，故为可治；臭烂是既交会之后，
火盛毒化，气血不能约束，只须扶其气血，火退自平，若能于浆足之时，早加白芍以制之，则无臭烂之患。○
臭痘多在头面，火气从上也；灰白先见天庭，元气不充也；发 多在四肢，土不胜水也；倒 先见颈项，内攻
之门户也。○用药之法∶暑月要表得轻、清得猛、转得快；天寒要表得透、清得缓、转得迟。○体实之儿，前面
表得开、下得通、清得透，后面便受得补；体虚之儿，前面清得艰难，后面便补得碍手。○痘之传染，如放花爆，
药线一着，势无停止，似无需乎药力。其所以用药者，开其表，使之易发；清其火，使无燔烁而损脓；补其气
血，助其出之尽也。翁氏立此三法，痘之大体不外乎此。而杂证相干，治无定法。（《橡村痘诀》）
痘疹与伤寒相类，头痛身热，足冷脉数，疑似之间，只与升麻汤解之，痘发未发皆可服，但不可疏利。伤
寒表邪，固不可下，痘疹发热在表，尤不可下。世人不察，乃云初觉以药利之，宣其毒也。误矣！（《活人书》）
昔人云痘疮首尾俱不可下者，何也？盖首不可下者，言疮未显于表，下之则不得伸越；尾不可下者，言疮
已显于表，内无根蒂，下之则陷逆故也。又言温暖盖覆，不令通风，以痘未出，或身凉恶寒故也。后人执此二
语，不知天时之所加，人身之所盛，致误多矣。噫！首尾俱不可下者，以其始终脏腑无凝滞也。若有里证便结
者，安得不下？温暖不使通风者，以其发在冬时。若在夏令，痘虽未出，亦不用此也。（王好古）
壮热身疼头痛，不与小汗，表何由解？大肠久闭，毒攻腰胁，心腹胀满，不与微利，何由释去？（庞安常）
今之治痘者曰∶首尾不可汗下。听者和之曰∶痘宜温补，汗
下不可也。此亦喜补恶攻之遗弊耳！殊不知治痘之法，莫要于解毒，或攻或补，务使毒瓦斯得解而已。如其气血
和畅，营卫流通，表里无邪，其出则尽，其发则透，其收则时，非但不可汗下，虽温补亦不可用也。设使外感
风寒，约束皮肤，闭密腠理，疮出不快，此当汗之，令阴阳和，营卫通，而疮易出，毒得解散可也。苟不汗之，
则毒无从得出，留伏于内，未免闭门留寇之祸矣。如大热不退，烦渴转增，谵妄昏沉，便溺阻塞，此毒蓄于肠
胃之间，与谷气相并，宜急下之，使脏腑疏通，陈 涤去可也。苟不下之，则藏污蓄毒煎熬于中，得无养虎遗
患之悔乎？故大要曰∶谨守病机，各司其属。有者求之，无者求之。盛者责之，虚者责之。疏其血气，令其条
达，而致和平，此之谓也。（万密斋）
予尝治痘用四君子汤，加黄 、紫草多效。间有枯萎而死者，思之至忘寝食，恍然悟曰∶白术燥湿，茯苓
渗利，宜浆之不行也。乃减去二味，加糯米、乳酒，名保元汤。（汪石山）
治痘补虚当辨阴阳，尤惟阴分为重。何也？盖痘从形化，本乎精血。凡见点、起胀、灌浆、结痂，无非精
血所为，虽曰气为之帅，而实血为之主。且痘以阳邪，阳盛必伤阴。所以凡治痘者，最当重在阴分，宜滋润不
宜刚燥。故曰∶补脾不若补肾，养阴所以济阳。此秘法也。然血气本自互根，原不可分而为两，加参、 、白
术，虽云气药，若用从血药，则何尝不补血？归、芎、地黄，虽云血药，若用从气药，则何尝不补气？故见气
虚者，以保元汤，而佐以归、地；血虚者，以四物汤，而佐以参、 。盖气血本不相离，但主辅轻重，各有所
宜耳。（《景岳全书》）
痘出之始，兼风寒而发者，解散为主；兼伤食而发者，消化为主；兼惊恐而发者，利惊为主。有正虚不能
逐邪外出者，补益而助升发为主；若毒壅盛而不透者，发解为主。有始末两实者，前后清解；始末两虚者，前
后温补。似实而虚者，补益为主；似虚而实者，解毒为主。虚证变实者，治从实例；实证变虚者，治
从虚例。先天之气足，后天之气不足者，补中气为主；先天之气不足，后天之气足者，补元气为主。（朱惠民）
升发之妙，非仅以提为升、疏为发，疏第可以逐寒邪、散风热，提第可以助清阴、发真气。不惟真虚、真
寒、恶火、恶毒所不能调济，即如饮食停滞，暑湿秽气，孰非阻窍脉而碍气道者，其得以兼摄否耶？必审其何
痘宜疏当不虚其表，何痘宜升当不提其毒，何痘宜升发并行两用而两得其效，何痘可以升发无藉即得以无事为
工，何痘宜宽中，何痘宜清彻，何痘以不发为发，不以疏为例，何痘以不升为升，不以提为则。总令气之得以
直达，不为毒锢，不为火蚀，不为邪郁，不为秽闭，不使窒碍，不使消沮，得以拘领其毒，而出升发之梗概，
庶乎其得之矣。得此机关，苦寒如芩、连，辛热如桂、附，补塞如参、 ，荡涤如硝、黄，何莫非升发之剂乎？
（费建中）
自有方书治痘以来，其时不啻二千年，其人不啻数百家，然皆详于已出之后，略于未出之前。深言出速而
稠密之害，不言留中而不出之殃。不知已出之毒，外寇也；未出之毒，内寇也。出速而稠密者，外攻也；留中
而不出者，内攻也。内寇与外寇势孰急？外攻与内攻祸孰烈？故痘已出而死者，多在旬日之间；痘不出而死者，
多在六朝之内。徒知御外寇，而不知逐内寇。昔贤之为计疏也。然其失计安在？惟在未出而急于解毒，缓于逐
General Discussion
Good variolae (smallpox) resemble a tower, layered and neatly stacked; depressed variolae resemble a collapse, empty and lacking root. Good variolae are lustrous and bright, like pearls or peach blossoms; dangerous variolae are pitted and sunken, with deep ulceration and rot. (Huafeng Daoren)
In cases of variolae initially presenting with Qi deficiency, the body has mild fever, cold extremities, alternating chills and fever, mental fatigue, pale and lusterless complexion, reduced appetite, quiet sleep, and clear, regulated bowel movements and urination; this is undoubtedly a deficiency syndrome. Before the eruption appears, use Shenqi Yin (Ginseng and Astragalus Decoction) added with Zisu (Perilla Leaf), Baizhi (Angelicae Dahuricae Radix), and Fangfeng (Saposhnikoviae Radix). After the spots appear, use Shenqi Yin added with Chuanxiong (Ligusticum Chuanxiong Rhizome) and Jiegeng (Platycodonis Radix). After four days, heavily employ Shenqi Yin, modifying according to symptoms. After seven or eight days, when the pustules are full, use Baoying Baibu Tang (Infant Protection Hundred-Tonics Decoction) to nourish and regulate Qi and Blood. ○ In cases of variolae initially presenting with Blood heat, the body has high and vigorous fever, red cheeks and face, dry and withered hair, irritability and thirst for water, crying day and night, restless sleep, and dark, scanty, and painful urination; this is undoubtedly a heat syndrome. Before the eruption appears, use Shengma Gegen Tang (Cimicifugae and Puerariae Decoction) or Shengma Liushi Yin (Cimicifuga Qi-Regulating Decoction). After the spots appear, Shishen Jiedu Tang (Ten-Spirit Detoxification Decoction) is stable. By the third or fourth day, when heat signs subside and the condition is about to enter the pustule stage, modify Taiyi Baohe Tang (Supreme Harmony-Preserving Decoction). After eight or nine days, when the pustules are full, use Baoying Baibu Tang for nourishment. ○ Excessive exterior heat leads to dryness and withering; excessive exterior cold leads to ice-like stagnation. Excessive interior heat leads to constipation; excessive interior cold leads to diarrhea. Qi stagnation leads to abdominal distension, wheezing, and chest fullness. If heat-toxin is suppressed and cannot extend outward, it leads to abdominal distension and madness. If toxic vapors are excessively abundant, both interior and exterior suffer severely, which infants and children cannot bear. Therefore, the method for treating variolae lies in five aspects: calming the exterior, harmonizing the middle, regulating Qi, penetrating the muscles, and resolving the exterior. Calm the exterior to prevent dryness and ice-stagnation; harmonize the middle to prevent constipation or diarrhea; regulate Qi to prevent excessive stagnation and wheezing; penetrate the muscles so that heat-toxin can extend and reach the exterior; resolve toxins so that interior and exterior toxins can be dispersed. If these five points are not missed, then even if the syndrome involves Blood heat and stagnation, and the variolae are dense, there is no need to worry. (Weng Zhongren)
If variolae erupt densely immediately with severe conditions, one should lightly release the exterior and cool the interior. If already erupted, dense with slight wheezing and thirst for warm water, add mild purgatives to wind-dispelling herbs. If eruption is slow but bowel movements and urination are clear and regular, knowing the pathogen is in the exterior not the interior, one should mildly disperse. If the color is green, dry, black, and sunken, with mild fever and constipation of stool and urine, the heat is internal, and purgation is indicated. If there is high fever and exterior signs have not resolved, purgation is contraindicated. If variolae have erupted with mild fever and dysuria, diuresis is indicated. If residual toxins remain after variolae, accompanied by fever and sores, detoxification is appropriate. If variolae have erupted or not, but the voice is absent, clearing the Lung is indicated. (Zhang Jiegu)
Is there anything other than variolae? It is merely the toxic pathogens floating in Qi and Blood. Is there another method for treating variolae? It is merely to digest the floating toxic pathogens and protect the integrity of Qi and Blood. Thus, before eruption, scatter them; after eruption, repel them; after repelling, transform them. Mastering these three allows one to preserve innate vitality. (Huangdi Yidian)
Mr. Guiyan said: Variolae are named after their shape. I believe they are not only named after their shape; the method of treating variolae is also like farmers planting beans. Beans are difficult to sprout in compacted soil and difficult to grow in barren soil. Therefore, compacted soil must be loosened, barren soil must be irrigated, and neither compacted nor barren soil requires only following its nature without harming it. Understanding this allows one to discuss medicine. Nowadays, people, upon the onset of variolae, do not examine deficiency, excess, cold, or heat, or overuse Wuxiang San (Aucklandia Powder) or Yigong San (Extraordinary Efficacy Powder), thereby adding fire to fire, leading to purple-black discoloration, inverted eruption, carbuncles, vomiting blood, or epistaxis. Or they recklessly use cold-cooling drugs like Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus), and Huangbai (Phellodendri Cortex), severely damaging the Spleen and Stomach, leading to vomiting, diarrhea, or cold shivering with internal inversion. Therefore, the method for treating variolae before the sixth day should not involve warming tonification, nor reckless use of cold-cooling drugs. The Master said: Within detoxification, slightly add warming tonification; within warming tonification, slightly add detoxification. This is an untransmitted secret. (Cheng Chenfeng)
With foot heat, red cheeks, constipation, dark urine, incessant thirst, upper Qi rebellion, and a surging-rapid pulse, these seven signs indicate hot medicines must not be taken. With cold feet, abdominal deficiency-bloating, pale complexion, clear stool, spitting milk, blue eyes, and a deep-thin pulse, these seven signs indicate cold medicines must not be taken. (Lv Cangzhou)
There are two types of variolae syndromes: one is Blood heat with abundant toxin; the other is Qi deficiency with abundant toxin. Qi deficiency with non-abundant toxin can be slowly tonified. Blood heat with abundant toxin has an urgent course. Upon first fever, there is thirst, red face, wheezing, mania, and delirium; upon first appearance of spots, one must immediately cool Blood and resolve toxin, grinding Xijiao (Rhinocerotis Cornu) juice for frequent drinking. Four or five out of ten may be cured; delay makes rescue difficult. There are also cases of Blood heat combined with Qi deficiency. Initially, cool Blood and resolve toxin; after five or six days, jointly tonify Qi to assist pus formation. If Blood is not cooled early, toxin remains unresolved; delaying to the sixth or seventh day forces the use of Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix) to assist pus, but pus will not form, instead nourishing toxic fire. There are also cases of Blood heat with abundant toxin resembling Qi deficiency: initial fever and eruption, confused spirit, cold feet, white variolae like water blisters, distinguished as fire syndrome only by swollen lips and thirst. Doctors failing to examine this and treating as Qi deficiency result in zero survival out of ten. (Miao Zhongchun)
Uniform Qi in variolae leads to rapid eruption. Therefore, during eruption, warmth is suitable, akin to the generating Qi of spring, ensuring smooth Qi and Blood flow for rapid, thorough, and uniform eruption. Bias toward heat consumes Qi with fierce fire, causing Qi deficiency and inability to move; bias toward cold causes Qi coagulation and inability to move. (Zhang Congzheng)
Resolve fire-toxin to fear depression leading to dryness; nourish Blood and Qi to desire circulation and comfort. (Wan Muzhai)
Treating variolae requires resolving toxin, harmonizing the middle, and calming the exterior. Tonify deficiency, reduce excess, warm cold, and balance heat; this is the standard. It is like the steaming method of cooks, aiming only for looseness. ○ Generally, gray-white and quiet cases are viewed as cold; rising uniformly and restless cases are viewed as heat. (Zhu Danxi)
Five Essentials: 1. Complete eruption; 2. Full development and penetration; 3. Thick and full pus; 4. Uniform scabbing; 5. Thick crusts. ○ Five Auspicious Signs: 1. Normal diet; 2. Regulated bowel and bladder; 3. Red, vibrant, firm sores; 4. Quiet pulse, cool body, warm extremities; 5. Clear voice, calm movement. Not all five need be present; having one or two is auspicious. ○ Seven Malignant Signs: 1. Irritability, confusion, delirium; 2. Vomiting, diarrhea, anorexia; 3. Black sunkenness, dryness, itching-collapse, rupture; 4. Premature head/face swelling, flaring nostrils, raised shoulders, wide eyes, cracked lips; 5. Throat/tongue ulceration, immediate vomiting upon eating, choking upon drinking; 6. Cold shivering, teeth grinding, hoarse voice, dark complexion; 7. Abdominal distension, wheezing, cold extremities. Not all seven need be present; having one or two is difficult to treat. ○ Four shapes/syndromes of variolae: Toxin obstruction, Blood heat, Qi deficiency, Blood deficiency. Four excesses/deficiencies: Exterior-Interior Excess-Deficiency. Dense spots, non-pointed shape, dull color, reluctant eruption indicates Toxin obstruction; deep red spots turning purple-black, with nodules and macules indicates Blood heat; sunken top, thin skin, flat collapse indicates Qi deficiency; pale color, scattered root, or variolae color identical to flesh indicates Blood deficiency. Mild fever with sweat indicates Exterior Deficiency; high fever without sweat, wheezing, scorched skin, muscle pain indicates Exterior Excess. Mental fatigue, pale lips/tongue indicates Interior Deficiency; mania, abundant Qi, thirst, good appetite, dry lips, yellow tongue indicates Interior Excess. Toxin obstruction and Blood heat correspond to Exterior-Interior Excess; Qi deficiency and Blood deficiency correspond to Exterior-Interior Deficiency. Obstruction requires dispersing; heat requires cooling; deficiency requires tonifying; excess requires purging; neither deficient nor excess requires balancing agents. Although, distinguishing cold, heat, deficiency, and excess especially relies on the tongue as the guideline. ○ Four steps in treating variolae must not be disordered; disorder leads to inverted Qi and Blood, rampant fire-toxin, and swarming symptoms. Thus,惊 (startle), 狂 (mania), 吐 (vomiting), 泻 (diarrhea), 斑 (macules), 疹 (rash), waist/abdominal pain, flesh-swollen but sore-not-swollen, choking water/throat obstruction are all due to failure to disperse, causing toxin obstruction in the Triple Burner; 焦紫 (scorched purple), 枯黑 (withered black), thirst, restlessness, developing nodules/toxins, rotten stomach/bad breath are all due to failure to clear, causing Yangming interior heat. Failure to tonify when needed leads to white sunkenness, diarrhea, itching-collapse, inverted scabbing, external peeling/internal attacking, indicating Middle Qi deficiency; failure to drain/diffuse when needed leads to rebound high fever, poor appetite/vomiting/diarrhea, or muscle/scab rot, due to Spleen dampness invading internally. Markers differ from roots, but origins combine; if medication matches the stage, transformed symptoms cease. ○ Some variolae require sweating; sweat them. Failure to sweat when required leads to later transformation. High fever, dry skin, wheezing, facial edema allow sweating. Hidden eruption, flesh-swollen sore-not-swollen, toxin stagnation preventing pus formation, or cold-induced inverted scabbing allow sweating, though combining resolution or tonification varies. Clearing or purging is verified by yellow-dry tongue coating; warming or tonifying is verified by pale-moist tongue. ○ Medications for variolae must not be excessive. Too hot causes desiccation; too cold causes coagulation; too drying consumes Blood; too moistening causes loose bowels; too attacking damages True Qi; too tonifying aids pathogen. ○ Treating variolae syndromes while ignoring mixed syndromes is an ancient secret theory. Mixed syndromes have duration; variolae syndromes have only two seven-day periods. Moreover, mixed syndromes in variolae arise from mismanagement; treating mixed syndromes while ignoring variolae worsens both. (Ciyou Fa)
Mixed syndromes arising from variolae syndromes are best treated by addressing variolae; variolae syndromes hindered by mixed syndromes are best treated by managing mixed syndromes. (Xu Zhongguang)
Variolae are like chess, with maximum changes, never repeating patterns. Formulas for variolae must adapt to circumstances; rigid formulas are useless. ○ The whole of variolae consists of three characters: Qi, Blood, Toxin. Analyze from these three. They must be separated and combined; separation is diagnosis, combination is treatment. ○ Variolae have three barriers: eruption, filling with pus, and recovery. Success requires passing all three. ○ Filling depends on eruption; scabbing depends on filling. No eruption without leaving the flesh can fill; no pale/clear pus can scab. ○ Eruption depends on Heaven; filling depends on Constitution; failure to recover is the doctor's fault. ○ Upon seeing fever, guard against closure; do not wait for irritability/macules to realize closure. Upon seeing complete eruption, think of filling; do not wait for gray/white/purple/black to worry about lack of filling. Upon seeing filling, think of recovery; do not wait for collapse/inversion to realize difficulty. Like chess, seeking initiative at every step ensures perfection. ○ Itching-collapse is internal attack; foul rot is external exit; carbuncles/spiral nodules are failed attempts to attack or exit. ○ Itching-collapse is untransformed toxin; ghost swelling is half-transformed toxin; foul rot is post-transformation toxin; carbuncles/spiral nodules are incompletely transformed toxin. Understanding these states reveals medication usage. When Qi and Blood intersect, toxin transforms. Itching-collapse means Qi and Blood did not intersect, hence incurable; ghost swelling/nodules mean intersection was blocked mid-way, hence treatable; foul rot means after intersection, fire was strong and toxin transformed, but Qi/Blood could not constrain it; supporting Qi/Blood allows fire to retreat and peace to return. Adding Baishao (Paeoniae Radix Alba) at peak pus formation prevents foul rot. ○ Foul variolae often on head/face, fire Qi rises from above; gray-white first on forehead, Yuan Qi insufficient; scabbing often on limbs, Earth fails to control Water; inverted scabbing first on neck, gateway for internal attack. ○ Medication principles: Summer months require light exterior release, fierce clearing, quick transition; cold weather requires thorough exterior release, slow clearing, delayed transition. ○ Robust children tolerate opening exterior, purging, and clearing early, allowing tonification later; weak children struggle with early clearing, hindering later tonification. ○ Variolae transmission is like fireworks; once lit, momentum stops not, seemingly needing little medicinal force. Medication opens exterior for easy eruption; clears fire to prevent burning and damaging pus; tonifies Qi/Blood to assist complete eruption. Mr. Weng established these three methods, covering the general principle of variolae. Mixed syndromes interacting have no fixed treatment. (Xiangcun Doujue)
Variolae resemble Shanghan (Cold Damage): headache, body heat, cold feet, rapid pulse. In doubt, use Shengma Tang (Cimicifuga Decoction) to resolve; usable whether erupted or not, but never purge/drain. Exterior pathogens of Shanghan must not be purged; heat of variolae in the exterior must especially not be purged. People failing to observe claim early purging disseminates toxin; this is wrong. (Huoren Shu)
Ancients said variolae should not be purged at beginning or end. Why? Beginning: sores not yet manifest externally, purging prevents extension. End: sores manifest externally, lacking internal root, purging causes inversion. Also, keep warm and covered, avoid drafts, because sores not out or body cold/chilly. Later generations adhered to these two phrases, ignoring climate and constitution, causing many errors. Alas! "No purging at beginning or end" applies because organs/intestines have no stagnation throughout. If interior signs include constipation, how can purging be avoided? Keeping warm/avoiding drafts applies to winter eruptions. In summer, even if not erupted, this does not apply. (Wang Haogu)
High fever, body/head pain, without mild sweating, how is exterior resolved? Long-term large intestine closure, toxin attacking waist/flanks, abdominal distension, without mild purging, how is relief achieved? (Pang Anchang)
Current practitioners say: no sweating or purging at beginning or end. Followers agree: variolae suit warming tonification, sweating/purging forbidden. This is the legacy of preferring tonification and fearing attack! Unknown is that the essence of treating variolae is resolving toxin; whether attacking or tonifying, the goal is toxin resolution. If Qi/Blood are smooth, Ying/Wei circulate, no exterior-interior pathogens, eruption is complete, development is thorough, recovery is timely; not only is sweating/purging unnecessary, even warming tonification is unused. If external Wind-Cold constrains skin, closes pores, slowing eruption, sweating is indicated to harmonize Yin/Yang, circulate Ying/Wei, facilitating eruption and toxin resolution. Without sweating, toxin has no exit, stays inside, causing "closing door to leave bandit" disaster. If high fever persists, thirst increases, delirium/coma occurs, urinary/fecal blockage, toxin accumulates in intestines/stomach with grain Qi, urgent purging is needed to clear organs and remove old filth. Without purging, filth/toxin simmers inside, risking "nourishing tiger leaving trouble" regret. Thus, the main point is: strictly observe disease mechanism, assign to respective categories. Seek what exists, seek what doesn't. Blame excess, blame deficiency. Disperse Qi/Blood, ensure smooth flow, achieve harmony. This is it. (Wan Muzhai)
I once treated variolae using Sijunzi Tang (Four Gentlemen Decoction) plus Huangqi (Astragali Radix) and Zicao (Arnebiae Radix) with much effect. Occasionally patients withered and died; thinking deeply until forgetting sleep/food, I suddenly realized: Baizhu (Atractylodis Macrocephalae Rhizoma) dries dampness, Fuling (Poria) drains leaching, preventing pus formation. So I removed these two, added Nuomi (Oryza Sativa Glutinosa) and Rujiu (Milk Wine), naming it Baoyuan Tang (Protect Origin Decoction). (Wang Shishan)
Treating variolae deficiency requires distinguishing Yin/Yang, especially prioritizing Yin aspect. Why? Variolae take form from Essence-Blood. From spotting, swelling, pus-filling, to scabbing, all are Essence-Blood work. Though Qi commands, Blood governs. Since variolae are Yang pathogens, Yang excess inevitably injures Yin. Therefore, treating variolae must prioritize Yin, favoring moistening/nourishing over rigid/drying. Thus: tonifying Spleen不如 tonifying Kidney; nourishing Yin assists Yang. This is a secret method. However, Qi and Blood are mutually rooted, inseparable. Adding Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), though Qi herbs, if used following Blood herbs, do they not tonify Blood? Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligusticum Chuanxiong Rhizome), Dihuang (Rehmanniae Radix), though Blood herbs, if used following Qi herbs, do they not tonify Qi? Thus, for Qi deficiency, use Baoyuan Tang assisted by Danggui (Angelicae Sinensis Radix) and Dihuang (Rehmanniae Radix); for Blood deficiency, use Siwu Tang (Four Substances Decoction) assisted by Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix). Qi and Blood are inseparable; only primary/secondary weight differs. (Jingyue Quanshu)
At start of eruption, if combined with Wind-Cold, dispersion is primary; if combined with Food Stagnation, digestion is primary; if combined with Fear/Terror, calming shock is primary. If Zheng Qi is too weak to expel pathogen externally, tonification assisting rising/generating is primary; if toxin obstruction is abundant and不透 (not penetrating), dispersing/resolving is primary. If both beginning and end are excess, clear/resolve front and back; if both beginning and end are deficiency, warm/tonify front and back. Resembling excess but actually deficiency, tonification is primary; resembling deficiency but actually excess, detoxification is primary. Deficiency transforming to excess, treat as excess case; excess transforming to deficiency, treat as deficiency case. Innate Qi sufficient, Postnatal Qi insufficient, tonify Middle Qi primarily; Innate Qi insufficient, Postnatal Qi sufficient, tonify Yuan Qi primarily. (Zhu Huimin)
The subtlety of rising/generating is not just lifting as rising, dispersing as generating. Dispersing only expels Cold/Wind-Heat; lifting only assists Clear Yin and generates True Qi. Not only can it not regulate true deficiency, true cold, aversion to fire/toxin, but also food stagnation, summer-heat dampness, foul qi, all blocking orifices/Qi channels, can they be simultaneously managed? Must examine which variolae suit dispersing without emptying exterior, which suit lifting without raising toxin, which suit simultaneous rising/generating for dual benefit, which suit rising/generating without reliance achieving nothingness as work, which suit widening middle, which suit clear-penetration, which use non-emergence as emergence not taking dispersing as example, which use non-lifting as lifting not taking raising as rule. Total aim: Qi reaches directly, not trapped by toxin, burned by fire, depressed by pathogen, closed by foulness, not obstructed, not diminished, able to lead toxin, emerging the outline of rising/generating, thus obtaining it. Grasping this mechanism, bitter-cold like Huangqin/Huanglian, pungent-hot like Guizhi/Fuzi, tonifying-blocking like Renshen/Huangqi, scouring like Xiaoshi/Mangxiao, are all agents of rising/generating. (Fei Jianzhong)
Since medical books treated variolae, time exceeds two millennia, authors exceed hundreds, yet all detail post-eruption, neglect pre-eruption. Deeply speak of dangers of fast/dense eruption, ignore calamity of retention/non-eruption. Do not know: erupted toxin is external bandit; unerupted toxin is internal bandit. Fast/dense eruption is external attack; retained/non-erupted is internal attack. Which is more urgent: internal vs external bandit? Which more severe: external vs internal attack? Thus, death after eruption often within ten days; death without eruption often within six days. Only knowing to defend against external bandits, not knowing to drive out internal bandits. Ancient sages' plans were sparse. Where is the error? Only in being eager to resolve toxin before eruption, slow in driving [toxin]...